| NPI | 1528474673 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 225100000X Physical Therapist (Licence: MD 25006) |
| Additional Taxonomies | 225100000X Physical Therapist (Licence: ID PT-3507) |
| Enumeration Date | 2014-07-09 |
| Last Update Date | 2026-05-12 |